NEW DELHI: India is reporting higher childhood cancer deaths as compared to some of the developed countries like the UK and Canada due to various reasons, mainly delayed diagnosis, lack of access to treatment, shortage of skilled workforce, lack of beds, and need of equipment, said a latest first-of-its-kind comprehensive report.
The report by the National Centre for Disease Informatics and Research (NCDIR) under the Indian Council of Medical Research (ICMR), Bengaluru, in collaboration with the World Health Organisation (WHO)-India, said childhood cancers (0-14 years) comprise four per cent of all reported cancers in the ICMR-NCDIR’s national cancer registry programme.
According to Dr Prashant Mathur, Director, NCDIR, they found barriers in providing timely and optimal treatment to children with cancers in the country.
“Delayed diagnosis and treatment could lead to higher rates of deaths and poor survival,” Mathur said, adding that the study is the first of its kind comprehensive report covering 26 states and four union territories in India to assess infrastructure, facilities, drug availability, finances, skills, training, research and barriers towards optimal childhood cancer care services.
The report, ‘A situational analysis of childhood cancer care services in India 2022,’ said the age-adjusted incidence rate (AAR) of childhood cancer (0-14 years) worldwide is 140.6 per million person-years.
In India, New Delhi shows the highest AARpm among boys (203.1) and girls (125.4), while in southern India, Chennai ranks second among boys (146.7) and third among girls (52.7) in childhood cancer incidence.
In the northeast, the AARpm was the highest in Aizawl among boys and girls (133.9 and 91.4, respectively). The study found a higher incidence in males compared to females.
The study said nearly 49 percent of paediatric cancers in India remain undiagnosed. “Delayed diagnosis and treatment lead to poorer outcomes. Inadequate/incomplete treatment prolongs the disease and its associated complications. These children are unable to attain optimal growth and development,” he added.
The study, based on a survey in 137 tertiary level hospitals, and 92 secondary level hospitals, said the most common primary sites of pediatric cancers include blood, bone, and brain.
Some of the most common malignancies include leukaemia, lymphoma, central nervous system (CNS), tumours of the bone and soft tissue and “blastomas” that affect different solid organs.
“Most pediatric cancers are curable with long survival when diagnosed and treated timely,” Dr Mathur told The New Indian Express.
He added that the current cancer control initiatives are more tuned to deal with adult cancers. “A childhood cancer policy is the need of the hour,” he said, adding that there is a need to create awareness among doctors who deal with children, other health professionals, parents and society.
The report found that the lack of essential infrastructure for diagnosing and treating childhood cancer – seen equally in both public and private hospitals - is one of the significant causes of treatment abandonment, ranging between 10-63 per cent.
The report also said that the proportion of children affected might be higher owing to “missed cases” due to low coverage, lack of awareness, delayed diagnosis and a fledgling electronic referral system.
A Brief Look at the Study
Childhood cancer care services were provided at over one-third (39.1%) of the secondary level hospitals, which was higher for private (56.5%) than public (32.8%) hospitals
Dedicated paediatric oncology departments were available in less than half of the public and private tertiary hospitals.
At public tertiary hospitals, less than half of the hospitals had a pediatric oncologist (48%), pediatric Oncosurgeon (14.2%), pediatric intensivist (38.9%), medical oncologist (46.7%) and palliative care physician (37.6%).
In secondary-level public hospitals, treatment was mainly through pediatric medicine departments.
Shortage of hospice care services at tertiary hospitals and medical social services at secondary hospitals
Over three-quarters (76.6%) of the public tertiary hospitals adopted a multidisciplinary team approach for childhood cancer treatment, compared to 35% of the private hospitals.
Availability of a dedicated pediatric oncology department at tertiary hospitals: public - (41.6%); private- (48.6%); charitable- (64%)
39.1% of secondary-level hospitals provide childhood cancer care services.
Less than 50% of the tertiary hospitals provided hospice care, play therapy and parental support groups
Less than half of the public tertiary hospitals, palliative care drugs, antineoplastic drugs, and targeted therapies were available in stock
Drugs for palliative care, antineoplastic drugs and targeted therapies were available, free of cost, at less than 50% of the public tertiary hospitals.
The most commonly adopted financing mechanism was comprised of the Ayushman Bharat Scheme at public tertiary level hospitals (81.8%) and secondary level public hospitals (61.9%)
Most paediatric cancer care centres in India are in urban areas, leading to delayed access by the rural population.
Less than 35% of the public and charitable tertiary level hospitals provide Haemopoietic stem cell transplantation (HSCT)
Over two-thirds of public tertiary hospitals had referral linkages with lower-tier non-childhood cancer-speciality treating facilities, versus 45.7% of private hospitals
Over 80% of the tertiary hospitals had facilities for CT scans, MRI and ultrasonograms; however, the availability of bone scans and PET scans was lower, especially in public sector hospitals